But, then, there are the data. We can hardly perform a study comparing abstinence treatment with controlled drinking treatment — for any group of alcoholics — which fails to suggest that their outcomes are equivalent. Oh, we can toy with the definitions (for Vaillant, a successful abstainer might have up to a week of relapse, while even a day of drunkenness rules against a successful controlled drinking outcome), but such results constantly pop up. And therapy organized around producing complete abstinence — never does so (and when it does, as it did at John Wallace's fabled program, he claimed, no one believes it and people are perfectly content to see the program shut down). The most remarkable example of this was in the abstinence-oriented Project MATCH research conducted under the auspices of an abstinence-fixated NIAAA and its head, Enoch Gordis. But what were the results — in the outpatient treatment alone component, only a fifth abstained for as long as a year after treatment; for the outpatient follow-up to hospital care, the year-long abstinence rate was a third. So, instead, controlled-drinking-hating Gordis and the NIAAA noted that, on average, alcoholics reduced drinking from 25 to 6 days a month, and from 15 to 3 drinks per occasion — how else could they justify the $27 million they spent to show that matching alcoholics with treatments would enhance outcomes, when it did not?

Such results will never disappear; they are real. They will always crop up; they cannot help but do so. The lackluster results from encouraging and measuring abstinence are the one thing history proves to us over again (rather than that alcoholism is a disease and that abstinence the only cure). And so, to lash out at heretics, as inconsequential and beleaguered a group as they appear to be, never gains the final abstinence uber alles conquest always just eluding abstinence adherents. It is so tantalizingly near; they must press on. The minor successes or failures of these controlled-drinking "forces" only serving to spur the rancor and vehemence of the dominant powers — who control all official treatment and research agencies in the U.S. already. Nonetheless, the just-released 10th Special Report to the U.S. Congress on Alcohol and Health noted:

Relatively little is known about developmental pathways that bring about change in a person's diagnosis of alcoholism over the adult life course. However, research has shown that the progression of alcoholism is not uniform for all individuals, whether or not they are treated. That is, not all alcoholics remain actively alcoholic after the onset of the disorder. A general population study investigated stability and change in measures of alcohol abuse and dependence over 4 years among male drinkers (Hasin et al. 1990). Of those originally classified as alcohol dependent, 46 percent still reported indicators of dependence 4 years later, 15 percent had moved to the abuse only category, and 39 percent no longer reported any indicators of alcohol abuse or dependence. Of those originally classified as alcohol abusers, 24 percent remained in the abuse only category, 30 percent reported indicators of alcohol dependence with or without indicators of abuse, and 46 percent no longer reported any indicators of alcohol abuse or dependence.

References

Hasin, D.S., Grant, B., Endicott, J. (1990), Natural history of alcohol abuse: Implications for definitions of alcohol use disorders. American Journal of Psychiatry, 147(11):1537-1541.

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